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62 Cards in this Set

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  • Back
The abdominal esophagus is the distal portion of the esophagus below the _______________

What is it innervated by?
esophageal hiatus of the diaphram


anterior & posterior vagal trunks from the esophageal plexus of nerves
What are the primary functions of the upper & lower esophageal sphincter?
upper- prevents entrance of air during respiration
(^located at pharyngoesophageal junction)

lower- guards against gastroesophageal reflux
(^located at esophageal hiatus of diaphram)
Obj.
Describe the 3 esophageal constrictions
1. cervical constriction
-upper esophageal sphincter

2. thoracic constriction
-arch of aorta & left main bronchus

3. diaphragmatic constriction
-lower esophageal spincter
Clincially, esophageal constrictions are important for:
-passing an instrument through esophaus & into stomach
-interpreting radigraphs of patients w/ dysphagia
-swallowed foreign objects
-caustic fluids cause strictures
Obj.
What does achalasia cause & why might it occur?
causes: failure of lower esophageal sphincter to relax, leading to dysphagia, regurgitation, chest pain & bird-beak appearance on radiograph

due to: absence of ganglion cells w/i wall of esophagus
causes: failure of lower esophageal sphincter to relax, leading to dysphagia, regurgitation, chest pain & bird-beak appearance on radiograph

due to: absence of ganglion cells w/i wall of esophagus
Obj
A hiatal hernia is a predisposing factor for longitudinal tears in the distal esophagus & gastroesophageal junction. What may this tearing lead to?
Upper GI bleeding (10% of cases), presenting as hematemesis
What else may result in longitudinal tearing of the esophagus, known as Mallory-Weiss tears?
severe retching or vomiting due to acute alcohol intoxication
T/F
The stomach may vary in its position depending on patients posture and body type
TRUE
What are the 4 main parts of the stomach?
1. cardia
2. fundus
3. body
4. pyloric
(subdivided into antrum & canal, whose junction is indicated by the angular incisure)
1. cardia
2. fundus
3. body
4. pyloric
(subdivided into antrum & canal, whose junction is indicated by the angular incisure)
*also note, lesser (facing liver) and greater (inferior/left) curvature
The pyloric region has a thickened ring of circular smooth muscle , the ________________, which controls passage of chyme into the duodenum under ___________ nerve control
pyloric sphincter


vagus nerve (parasympathetic) control
Obj
Congenital hypertrophic pyloric stenosis is marked by what symptom?
hypertrophy of the pyloric sphincter, inhibiting gastric emptying w/ non-bile stained, severe "projectile" vomiting, presenting as 4-8 wks in infants 
(secondary dilatation of stomach)
hypertrophy of the pyloric sphincter, inhibiting gastric emptying w/ non-bile stained, severe "projectile" vomiting, presenting as 4-8 wks in infants
(secondary dilatation of stomach)
The _______ attaches the stomach from the lesser curvature to the liver.
The _______ attaches the greater curvature to the posterior body wall, spleen, & diaphragm & also migrates to wall off inflamation
less omentum

greater omentum
Of the 2 main types of hiatal hernias ________________ does NOT result in regurgitation of gastric contents (& is less common) & ____________ DOES and may lead to Barrett's esophagues
parasophageal hiatal hernia (does NOT)

sliding hiatal herna (DOES)
Obj.
If medical treatment of gastric ulcers is unsuccessful _____________may be performed.
In some instances this procedure must be accompanied by _________________ to allow gastric emptying (since sphincter cant relax)
vagotomy= surgical section of the vagus nerve


drainage procedure (ie pyloroplasty)
obj
Duodenal ulcers may cause fatal ________ from the ______________ artery.
hemorrahage

gastroduodenal branch of the celiac artery

*may result in peritonitis (superiorly) or pancreatitis (inferiorly)
obj
Describe the development of gallstone ileus
-an inflamed gallbladder may adhere to superior duodenum & pass gallstone into it through a cholecystenteric fistula
-a gallstone entering this way may obstruct the ileocecal valve, producing gallstone ileus
Obj
What may hepatopancreatic ampulla obstruction be caused by?
what may it lead to?
-obstruction may be caused by gallstones becoming lodged or tumors forming w/i the narrow hepatopancreatic ampulla

-may lead to bile flow backing up into pancreatic duct causing bile pancreatitis/gallstone pancreatitis
Obj
What is superior mesenteric artery syndrome?
-The inferior 3rd of the duodenum passes btwn the superior mesenteric artery & aorta where it becomes compressed & completely obstructed

*surgical emergency
Obj
Differentiate btwn characteristics of upper GI and lower GI bleeding
Upper- typically produces vomiting of blood (hematemesis) and/or black tarry stool (melena)

Lower- bright red rectal bleeding (hematochezia)

*ligament of Treitz is the junction point btwn upper & lower GI
The ______________, where the small intestine transitions from retriperitoneal to intraperitoneal is a frequent site for peritoneal folds & _________
duodenojejunal junction

paraduodenal fossae (recesses)
Obj
A loop of small intestine may become entrapped w/i a paraduodenal fossae as a _________________ & have to be surgically freed
During surgery what artery & vein are at risk of damage?
paraduodenal /internal hernia



inferior mesenteric artery & vein
How are the jejunum & ileum distinguished by blood supply?
jejunum- has FEW arterial arcades & LONG vasa recta in mesentary w/ LITTLE fat

ileum- has MANY arterial arcades & SHORT vasa recta in mesentary laden (LOT) w/ fat
jejunum- has FEW arterial arcades & LONG vasa recta in mesentary w/ LITTLE fat

ileum- has MANY arterial arcades & SHORT vasa recta in mesentary laden (LOT) w/ fat
How does the mucosa of the ileum & jejunum differ?
ilueum is smooth & jejunum has plicae circulares "feathery" appearance
ilueum is smooth & jejunum has plicae circulares "feathery" appearance
obj
What is an ileal (Meckel's) diverticulum?
it is a remnant of the embryonic vitelline duct (yolk stalk), contains all layers of intestinal wall= true diverticulum (may contain ectopic gastric or pancreatic tissue)

*most common congenital anomaly of small intestine
An ileal diverticulum usually follows the rule of 2's, what is the rule of 2s?
rule of 2s:
-it occurs in 2% pop
-is symptomatic in 2% of ppl w/ it
-is symptomatic in first 2 yrs of life
-is 2 in long
-is located w/i 2 ft of ileocecal junction
What may be caused be an ileal diverticulum?
-painless hemorrhage
-intestinal obstruction
-inflammation (diverticulitis)
-perforation
-pain mimicking appendicitis
-lower GI bleeding (hematochezia)
^ most common cause in children
obj
What are appendicitis signs and symptoms?
-vague central periumbilical pain that later becomes sharp, localized, right lower quadrant pain at McBurnery's point
-vomiting typically follows pain
-positive obturator or psoas signs
Differentiate btwn obturator & psoas sign
Obturator sign:
-pain on passive medial rotation of flexed R thigh
= inflamed pelvic appendix
-appendix in contact w/ fascia over obturator internus muscle

Psoas (iliopsoas) sign:
- pain against resisted flexion of R thigh (passive extension)
=inflamed retrocecal appendix
-appendix in contact w/ fascia over ilipsoas muscle
Where is McBurney's point located?
at a point 1/3  the distance on a line connecting the right ASIS & umbulicus
at a point 1/3 the distance on a line connecting the right ASIS & umbulicus
obj.
What is cecal volvulus?
Twisting of the cecum on itself, causes obstruction & compromises blood supply (strangulation)

^predisposable due to mobile ascending colon
obj.
Differentiate btwn the 2 major inflammatory bowel diseases; ulcerative colitis and Crohn’s disease
ulcerative colitis:
-begins in distal rectum & spreads into colon
-does NOT involve small intestine
-characterized by continuous inflammatory lesions involving mucosa & submucosa only

Crohn's disease
-involves terminal ileum & colon
-chara...
ulcerative colitis:
-begins in distal rectum & spreads into colon
-does NOT involve small intestine
-characterized by continuous inflammatory lesions involving mucosa & submucosa only

Crohn's disease
-involves terminal ileum & colon
-characterized by inflammatory lesions of ALL layers of bowel wall (transmural lesions)
-discontinuous "skip" lesions
-causes malnutrition
-intestinal obstruction & fistulas may occur
*both cause abdominal pain, bloody diarrhea, fever & predispose to cancer
Obj.
Sigmoid volvulus is made more likely by a (short/long) sigmoid mesocolon.

What does sigmoid volvulus result in?
long

-results in obstruction & infarction

*90% of colon volvulus cases involve sigmoid colon
obj.
Differentiate btwn diverticulosis and diverticulitis
diverticulosis:
-sigmoid colon prone to develop outpocketings of it's own wall
-often asymptomatic, can cause cramping, continuous low abdominal discomfort, bloating, constipation, diarrhea
-present in 50% ppl over 60yr

Diverticulitis:
-infected/inflamed diverticula
-may cause bleeding (intermittent or massive hemorrhage (rare), obstruction, or perforate
-fistula may form btwn colon & adjacent organs
If an infected diverticula perforates, what may result?
an absecess may form of infection may spread to produce generalized peritonitis
Obj.
What is Hirschsprung disease (congenital megacolon) and how does it present?
-portion of colon is dilated (megacolon) due to failure of peristalsis resulting from absence of autonomic ganglic w/i intestinal wall, distal to dilated segment
-absent ganglia due to arrest in migration of embryonic neural crest cells

-presents as denlargement & constipation in neonate

*most common cause of neonatal obstruction of colon
*10% of cases are in down syndrome children
The liver occupies most of the right __________, upper __________ & extends into the left __________+
right hypochondrium
upper epigastrium
left hypochondrium
right hypochondrium
upper epigastrium
left hypochondrium
Important ligaments of the liver:
______ contains to ligamentum teres hepatis & paraumbilical veins
____________ outlines bare area of liver & is continuous & triangular ligaments
__________ composed of hepatogastric & hepatoduodenal ligaments
falciform ligament

coronary ligament

lesser omentum

*also note R & L triangular ligaments
falciform ligament

coronary ligament

lesser omentum

*also note R & L triangular ligaments
Important functions of the liver (5):
1. carb metabolism
2. protein metabolism (produces blood clotting factors)
3. lipid metabolism
4. bile production
5. detoxification
obj
The livers attempts to detoxify may be overwhelmed in chronic alcoholism resulting in _____________

This condition may also result from what?
cirrhosis (fibrosis of the liver)


-viral inflammation (hep B & C), obstruction of bile drainage, etc
Unlike the rest of the body, in which venous drainage passes directly toward the sup or inf vena cava, venous drainage from the abdominal gastrointestinal system & spleen goes where?
enters the hepatic portal vein for transport to the liver
obj
What impairments to portal venous blood flow may result in portal hypertension?
Impairments:
-prehepatic (portal vein thrombosis)
-intrahepatic (cirrhosis)
-posthepatic (R-sided heart failure or Budd Chiari syndrome
What is Budd-Chiari syndrome?
hepatic vein thrombosis, prevents drainage of blood from liver into the inferior vena cava via hepatic veins
Obj
Portal hypertension complications and treatment
complications:
-esophageal varices (at gastroesophageal junction)--> fatal hemorrhage
-caput medusae (subcutaneous veins radiate out from umbilicus, secondary to paraumbilical veins)
-hemorrhoids (at anorectal junction)

treatment:
-portosys...
complications:
-esophageal varices (at gastroesophageal junction)--> fatal hemorrhage
-caput medusae (subcutaneous veins radiate out from umbilicus, secondary to paraumbilical veins)
-hemorrhoids (at anorectal junction)

treatment:
-portosystemic (portocaval) shunt btwn portal vein & inferior vena cava
-splenorenal shunt btwn splenic vein & left renal vein
Venous drainage of GI to liver also provides a pathway for what?
metastasis of cancer from GI into liver
The gallbladder recieves blood from cystic artery, which arises from the R hepatic artery within the cystohepatic triangle, what is this triangle formed by?
-common hepatic duct
-cystic duct
-visceral surface of liver
-common hepatic duct
-cystic duct
-visceral surface of liver
If the cystic artery or right hepatic artery is cut during cholecystectomy, how may a surgeon control bleeding?
Pringle maneuver-
surgeon may pass index finger through omental foramen & pinch hepoduodenal ligament btwn thumb & index finger
Pringle maneuver-
surgeon may pass index finger through omental foramen & pinch hepoduodenal ligament btwn thumb & index finger
Obj
Gallstones (cholelithiasis) may possibly cause what complications?
if it obstructs bile flow, bile will be absorbed into blood, causing:
-yellowing of skin, sclera, & mucous membranes (jaundice icterus)
If the gallbladder becomes inflamed (cholecystitis), pain may be referred from the diaphram to ____________ via the __________nerve
right shoulder
phrenic nerve
________________, may develop at the junction of the neck of gallbladder & cystic duct when gallstones become impacted at the _____________
Hartman's pouch (an abnormal sacculation)

hepatopancreatic ampulla
What is an endoscopic retrograde cholangiopancreatography (ERCP)?
-insertion of a cannula through the major duodenal papilla & hepatopancreatic ampulla for injection of radiographic contrast medium
Obj
Differentiate btwn acute and chronic pancreatitis
acute pancreatitis:
-ranges from mild & self-limiting to life threatening
-damage is REVERSIBLE
-presents w/ abdominal, epigatsric pain radiating to back, nausea, vomiting, fever
-commonly caused by alcoholism or gallstone bile flow obstruction

chronic pancreatitis:
-PERMANENT & progressive damage
-diminished exocrine & encodrine function
-may lead to chronic pain, weight-loss, diabetes mellitus, pancreatic cancer, pseudocyts
-may result from recurrent acute pancreatitis, autoimmune disorders, toxins, obstructions of pancreatic ducts, idiopathic
-genetic causes in children
*25 yr mortality is 50%
Pancreatitis frequently results in development of a ________________
pancreatic pseudocyst- an encapsulated (fibrous-walled) collection of pancreatic enzyme-rich fluid w/i pancreas
-most common location in in omental bursa (lesser sac)
What are some of the possible complications of pancreatic pseudocysts?
-compression or perforation of adjacent structures
-hemorrhage
-infection
-peritonitis
-pleural effusion
Obj,
Pancreatic cancer (of pancreatic head) commonly leads to what?
What is the first sign of this?
obstruction of bile duct


painless jaundice is first sign, however overall pain is the most common symptom, usually severe pain radiating to mid or lower back*
T/F
Spleen is part of the digestive system
FALSE

-however does share blood supply w/ GI
Where is the spleen located?

What are its functions?
location:
-intraperitoneal
-deep to L lower ribs 9-11
-long axis parallel to rib 10

function:
-antibody formation
-disposal of deteriorating RBCs & platelets
-stores blood
location:
-intraperitoneal
-deep to L lower ribs 9-11
-long axis parallel to rib 10

function:
-antibody formation
-disposal of deteriorating RBCs & platelets
-stores blood
The spleen is supplied by the _________________

it is drained by __________________, which joins to superior mesenteric vein to form the ______________
splenic artery (branch of celiac trunk)

splenic vein
portal vein

*the inferior mesenteric vein usually drains into the splenic veins
splenic artery (branch of celiac trunk)

splenic vein
portal vein

*the inferior mesenteric vein usually drains into the splenic veins
Obj
Common splenic pathologies-
-splenic artery may aneurysm during 3rd trimester
^rupture may cause fatal hemorrhage

-splenomegaly from hypertension of hemolytic anemia
The ________ is the most commonly ruptured abdominal organ w/ life threatening hemmorrhage

What are some common causes of rupture?
spleen


causes:
-blunt trauma to abdomen
-lacerated in L lower rib fracture
Splenectomy may be required to remove a ruptured spleen. What structure, that enters the splenorenal ligament may be injured during this procedure?
tail of the pancreas

*one or more accessory spleens may also be present
During splenic needle biopsy, the relationship of the spleen to the costodiaphragmatic recess (which descends to 10th rib at midaxillary line) is important to remember, to avoid what?
entering the pleural cavity which would cause pleuritis
entering the pleural cavity which would cause pleuritis
Splenic pain would be referred to the _________ via the ___________nerve
left shoulder
phrenic nerve